In 2018, the UN Committee on the Rights of Persons with Disabilities recommended the Russian Federation to amend the rules for establishing the degree of loss of professional ability to work in order to increase the level of transparency and efficiency of guarantees provided to workers injured as a result of accidents and occupational diseases.
Objective: to assess the need to amend the existing Temporary criteria for determining the degree of UPT based on an analysis of established expert practice in various constituent entities of the Russian Federation and other factors that can affect the severity of the consequences of work-related injuries and occupational diseases. To assess the existing practice of establishing the degree of loss of professional ability to work, expert decisions were analyzed in 77 constituent entities of the Russian Federation over the past 3 years, existing regulatory legal documents, indicators of the quality and accessibility of medical care in the constituent entities of the Russian Federation, as well as data on the duration of cases of temporary disability in injured persons at work . The analysis revealed a high level of variability of expert decisions made and the absence of a relationship between the quality and availability of medical care in the constituent entities of the Russian Federation and the length of time on the sick leave for the consequences of injuries at work. Given the high level of variability of expert decision making in the constituent entities of the Russian Federation for similar expert cases (coefficient of variation of 21.6%), the authors conclude that it is necessary to change approaches to the methodology for assessing the nature of professional activity (qualifications, quality and volume of work, ability to perform it) .
The tuberculosis (TB) dispensary patients are often diagnosed with cardiac diseases, but the regulatory documents associated with TB care refer to the procedures and standards of examination and treatment of TB patients or patients with suspected TB while the management of associated chronic diseases is carried out in other medical institutions. There is lack of continuity between doctors of diff erent specialties. Patients face organizational problems of accessibility and quality of medical care. The creation of Department of Medical and Social Care and Rehabilitation in TB dispensary with therapeutic profi le specialists became especially urgent in the period of coronavirus pandemic.Aim. The aim of the study was to estimate the expediency and eff ectiveness of Department of Medical and Social Care and Rehabilitation in detection and treatment of comorbid cardiac pathology in patients of TB dispensary during coronavirus (COVID-19) pandemic.Material and Methods. All patients of the St. Petersburg TB dispensary No. 5 were examined according to specially developed algorithm to detect and treat the cardiac pathology comorbid with TB. Results. Cardiac diseases comorbid with tuberculosis were detected using an integrated multidisciplinary approach to examination of TB patients during the pandemic of coronavirus infection. Examination, consultation, and necessary treatment were carried out directly in TB dispensary allowing to avoid disease exacerbations and complications during the entire period of monitoring.Conclusion. The establishment of Department of Medical and Social Care and Rehabilitation in TB dispensary No. 5 showed the relevance and timeliness of this measure. The coronavirus genesis of some cardiac diseases required to revise the management tactics of aff ected tuberculosis patients.
The case of asymptomatic 3rd stage myxomatous degeneration of the mitral valve in a 42-year old male patient is presented. The patient was referred to Tuberculosis dispensary No. 5 for investigation of pathological findings revealed by fluorography during the coronavirus pandemic period. The patient was examined by TB specialists and the general practitioner in accordance with new interdisciplinary diagnostic algorithms primary involving the GP. As а result of the detailed investigation the patient was found to have previously undiagnosed consequences of pneumonia caused by COVID-19 and 3rd stage myxomatous degeneration of the mitral valve.
The new coronavirus infection has put a number of urgent tasks for the professional community on the effectiveness and timeliness of which not only the life and health of patients depends, but the health and quality of life of the medical workers themselves, especially in the case of infection with COVID-19 in the line of duty. The high incidence of acute occupational diseases caused by COVID-19 among medical workers requires appropriate correction of the mechanisms and procedures for linking the disease with the profession, medical and social expertise, rehabilitation and insurance coverage. In the article, the authors analyzed both the existing ones and those that came into force during the development of the pandemic, regulatory documents and methodological recommendations regulating the connection between the disease of a new coronavirus infection and the profession, methodological approaches to medical and social examination and rehabilitation in case of medical workers becoming ill with a new coronavirus infection and its consequences. Reasonable algorithms for the actions of medical workers are presented, starting from the moment of detecting an occupational disease until the moment of examination at the bureau of medical and social expertise in the event of a persistent loss of professional working capacity.
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